Value in Health Care Accounting for Cost, Quality, Safety, Outcomes, and Innovation: Workshop Summary (2010) / Chapter Skim
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7 Aligning the System to Promote Value - Now and in the Future
7 Aligning the System to Promote Value - Now and in the Future
Pages 201-214
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From page 201... ...
. Many of the tools necessary to achieve this vision -- such as value-based insurance design, tiering, workplace wellness programs, electronic health records, patient-centered medical homes, and disease management programs -- were discussed at this workshop.
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; how health services researchers tout comparative effectiveness as a generator of data that will inform healthcare decision making and reshape the delivery of health care in this country; and finally, how others believe that educating consumers about the total costs of healthcare interventions and increasing cost sharing with patients will stimulate changes in behavior that will yield cost savings. Emanuel posited that all of these elements simply constitute pieces of a toolbox that need to be engaged simultaneously and synergistically to create disruptive evolution in health care.
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Although head-to-head trials with an active comparator offer richer data for informing routine clinical care, most drug regulatory authorities do not require them for registration purposes. This occurs, in part, because comparative studies will necessarily be larger and hence more costly, but also because what constitutes the current standard of care varies widely both within, and between, healthcare organizations.
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While emerging evidence of serious toxicity or significant benefits during a study is a valid reason for premature termination of the trial, there are also concerns that interim findings may represent -- by chance -- either false positive or false negative results (known, respectively, as "random highs" or "random lows")
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The EQ-5D considers societal preferences (derived from large population surveys) for various health states that enable comparisons of health gains to be made of different interventions across different conditions.
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Categories of Technology Advancement As we look toward the world of health care in the future, for example in the year 2025, the advances we envision are in areas where rapid progress is already occurring, such as imaging technologies, specialty pharmaceuticals, genetic targeting and personalized medicine, nanotechnology, robotics, and telemedicine. Just as advances in these fields will continue to emerge, there are very likely to be some advances in fields that we cannot even imagine.
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Even after repair of the hip fracture, there is a significant likelihood that the individual will not return to independent function and a more than 50 percent chance of needing prolonged nursing home care, with subsequent likely complications leading to death. Medical advances also include interventions that are not treating a disease necessarily but do enhance normal function and, therefore, quality
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Research is also improving mobility, in terms of both muscle strength without the adverse consequences of anabolic steroids and improving cartilage and synovial function in aging joints to avoid the need for joint replacement. Another example in this category involves sensory conditions, which are rarely considered serious medical problems.
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The most notable of these are the medical home demonstrations now under way, supported by healthcare payers and purchasers and soon to be an initiated under a major Medicare demonstration. In addition, there are small sites of innovation around transition management from hospital to home or to nursing home, as well as a drive for greater integration between specialists caring for a single individual.
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. Yet in the United States, an unresolved issue is the degree to which social justice is part of the fairness equation, as it is in other developed countries where the debate starts with the assumption that everyone should have coverage for basic health care.
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Rother from AARP. Their comments focused on the short- and longterm investment opportunities that would foster synergistic innovations and disruptive evolution towards increasing value in health care.
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The panel also discussed reorganizing care delivery systems to facilitate chronic disease management that will enable progressive quality improvement beyond current standards. Referencing Arnold Milsteinís discussion of
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He stated that identifying these sources and investing in the tools discussed during this workshop will be necessary to realizing the long-term savings and improved clinical outcomes achievable through their implementation. REFERENCES America's Health Insurance Plans.
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